Montana home care programs

Home health: the medical benefit

In Montana, skilled home health is Home Health Services. It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Montana Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Montana the agency route is Agency-Based Community First Choice Services and Personal Care Services (CFC/PAS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. Agency-Based Community First Choice Services and Personal Care Services (CFC/PAS) lets the agency hire a family member as the aide, with the agency still the employer.

Consumer-directed care: the person hires their own aide

Montana's consumer-directed option is Self-Direct Community First Choice Services and Personal Care Services (SD-CFCS/PCS). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Self-Direct Community First Choice Services and Personal Care Services (SD-CFCS/PCS) allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Montana has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Self-Direct Community First Choice Services and Personal Care Services (SD-CFCS/PCS)), by the hour, as the participant's chosen aide.

Other ways Montana pays for care at home

Waiver in-home services: Big Sky Waiver (BSW), Home and Community Based Waiver for Individuals with Developmental Disabilities, and Severe and Disabling Mental Illness Home and Community Based Services Waiver. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services).
• Needs daily help and wants an agency to supply and manage the aide: Agency-Based Community First Choice Services and Personal Care Services (CFC/PAS).
• Wants to choose the aide, including a relative where allowed: Self-Direct Community First Choice Services and Personal Care Services (SD-CFCS/PCS).
• Meets nursing-home level of care and needs more than personal care: Big Sky Waiver (BSW), Home and Community Based Waiver for Individuals with Developmental Disabilities, and Severe and Disabling Mental Illness Home and Community Based Services Waiver.